Predictors of Death from Complicated Severe Acute Malnutrition in East Ethiopia: Survival Analysis

Figures & data

Table 1 Co-Morbidity and Medical Conditions of Children Admitted to Stabilization Center in Dire Dawa, from 2017 to 2020 (n = 665)

Clinical conditions categories		Frequency	Percent
Vomiting	Yes	417	62.7%
	No	248	37.3%
	Total	665	100%
Dehydration	Yes	310	46.6%
	No	355	53.4%
Appetite test	Pass	504	75.8%
	Fail	161	24.2%
Grade of edema	+	43	6.5%
	++	83	12.5%
	+++	113	17%
	Non edematous (0)	426	64.1%
Pneumonia	Yes	286	43%
	No	379	57%
	Total	665	100%
HIV status	Positive	5	0.8%
	Negative	51	7.7%
	Unknown	609	91.6%
Diarrhea	Yes	401	60.3%
	No	264	39.7%
		665	100%
Anemia	Yes	304	45.7%
	No	361	54.3%
Malaria	Yes	2	0.3%
	No	663	99.7%
TB	Yes	23	3.5%
	No	642	96.5%
Hyperthermia	Yes	10	1.5%
	No	655	98.5%
Hypothermia	Yes	7	1.1%
	No	658	98.9%
IV fluid intake	Yes	148	22.3%
	No	517	77.7%
IV antibiotic treatment	Yes	651	97.9%
	No	14	2.1%
Naso-gastric tube	Yes	110	16.5%
	No	555	83.5%
Blood transfusion	Yes	91	13.7%
	No	574	86.3%

Notes: + – refers to pedal edema, ++ – edema of the leg, and +++ – generalized body edema.

Figure 1 Treatment outcomes of SAM children treated in stabilization center, Eastern Ethiopia.

Table 2 Life Table Showing the Survival and Hazards of SAM Children Treated in Stabilization Center, in Dire Dawa from 2017 to 2020, Ethiopia

Interval Start Time (in Days)	Subjects Entered	Subjects Censored	Subjects Exposed to Risk	Number of Terminal Events	Probability of Events (Death)
0	665	13	658.5	9	15%
3	643	73	606.5	21	35%
6	549	123	487.5	14	23.3%
9	412	135	344.5	3	5%
12	274	101	223.5	6	10%
15	167	51	141.5	3	5%
18	113	33	96.5	2	3.3%
21	78	31	62.5	0	0%
24	47	16	39	0	0%
27	31	10	26	1	1.7%
30	20	5	17.5	0	0%
33	15	4	13	1	1.7%
36	10	5	7.5	0	0%
39	5	1	4.5	0	0%
42	4	2	3	0	0%
45	2	2	1	0	0%
Total	3035	605	2732.5	60	100%

Figure 2 Hazard (1-survival) curve for admitted SAM children in stabilization center: from admission to outcome (death).

Table 3 Bivariable Cox Proportional Hazard Regression Model for Predictors of Death from SAM in Eastern Ethiopia

Predictor Variables		Outcome		CHR (95% CI)
		Dead	Censored
Age in months	≤ 24 months	39 (65%)	482 (79.7%)	1
	>24 months	21 (35%)	123 (20.3%)	0.80(0.61–1.05)
Sex	Male	25 (6.9%)	338 (93.1%)	0.57 (0.34–0.96) *
	Female	35 (11.6%)	267 (88.4%)	1
Resident	Urban	24 (8.6%)	256 (91.4%)	0.93 (0.56–1.56)
	Rural	36 (9.4%)	349 (90.6%)	1
Clinical form of malnutrition	Marasmus	38 (9%)	384 (91%)	1
	Kwashiorkor	19 (8.7%)	200 (91.3%)	0.86 (0.27–2.81)
	Marasmic-Kwashiorkor	3 (12.5%)	21 (87.5%)	0.73 (0.22–2.49)
Vomiting	Yes	42 (10.1%)	375 (89.9%)	1.42 (0.82–2.47)
	No	18 (7.3%)	230 (92.7%)	1
Dehydration	Yes	38 (12.3%)	272 (87.7%)	2.00 (1.18–3.38) *
	No	22 (6.2%)	333 (93.8%)	1
Appetite test	Pass	11 (2.2%)	493 (97.8%)	0.06(0.03–0.12) *
	Fail	49 (30.4%)	112 (69.6%)	1
Pneumonia	Yes	39 (13.6%)	247 (86.4%)	2.68 (1.58–4.56) *
	No	21 (5.5%)	358 (94.5%)	1
Diarrhea	Yes	45 (11.2%)	356 (88.8%)	2.16 (1.16–4.06) *
	No	15 (5.7%)	249 (94.3%)	1
Anemia	Yes	29 (9.5%)	275 (90.5%)	1.08 (0.65–1.79)
	No	31 (8.6%)	330 (91.4%)	1
Tuberculosis	Yes	5 (21.7%)	18 (78.3%)	2.85 (1.14–7.14) *
	No	55 (8.6%)	587 (91.4%)	1
Hypothermia	Yes	2 (28.6%)	5 (71.4%)	3.65 (0.89–14.97)
	No	58 (8.8%)	600 (91.2%)	1
IV fluid	Yes	28 (18.9%)	120 (81.1%)	3.23 (1.94–5.36) *
	No	32 (6.2%)	485 (93.8%)	1
IV antibiotics	Yes	59 (9.1%)	592 (90.9%)	0.88 (0.12–6.41)
	No	1 (7.1%)	13 (92.9%)	1
Blood transfusion	Yes	10 (11%)	81 (89%)	1.18 (0.60–2.35)
	No	50 (8.7%)	524 (91.3%)	1
Folic acid and Vitamin A	Yes	39 (7.6%)	474 (92.4%)	0.56 (0.33–0.95) *
	No	21 (21%)	131 (86.2%)	1
Deworming	Yes	18 (4.5%)	389 (95.5%)	0.27 (0.16–0.48) *
	No	42 (16.2%)	217 (83.8%)	1
NG tube	Yes	41 (37.3%)	69 (62.7%)	13.02 (7.54–22.48) *
	No	19 (3.4%)	536 (96.6%)	1

Note: *Refers to statistically significant predictors of time to death at 5% significant level.

Table 4 Multivariable Cox-Proportional Hazard Regression Model for Predictors of Death from SAM

Variables		Outcome		AHR (95% CI)	P-value
		Dead Freq. (%)	Censored Freq. (%)
Appetite test	Pass	11 (2.2%)	493 (97.8%)	0.15(0.64–0.34)	0.001*
	Fail	49 (30.4%)	112 (69.6%)	1
Pneumonia	Yes	39 (13.6%)	247 (86.4%)	2.43(1.42–4.16)	0.012*
	No	21 (5.5%)	358 (94.5%)	1
Diarrhea	Yes	45 (11.2%)	356 (88.8%)	1.96(1.08–3.56)	0.001*
	No	15 (5.7%)	249 (94.3%)	1
Tuberculosis	Yes	5 (21.7%)	18 (78.3%)	2.86(1.08–7.63)	0.087
	No	55 (8.6%)	587 (91.4%)
Deworming	Yes	18 (4.4%)	388 (95.5%)	0.36(0.20–0.64)	0.0001*
	No	42 (16.2%)	217 (83.8%)
NG tube	Yes	41 (37.3%)	69 (62.7%)	2.32 (0.15–4.72)	0.017*
	No	19 (3.4%)	536 (96.6%)

Note: *Shows a statistically significant predictors at p-value below 0.05.